华东地区农村高血压人群吸烟与肾功能下降的关系

The effect of smoking on renal function decline in rural hypertensive population residing in Eastern China

目的探讨我国华东地区（安庆及连云港）农村高血压人群吸烟与肾功能下降的关系,为慢性肾脏病的早期预防提供初步依据。方法选取20 702例45-75周岁的高血压患者。通过问卷调查收集研究对象的吸烟状况;根据CKDEPI公式估算肾小球滤过率（GFR）以评估肾功能。结果20 312例受试者纳入最终分析,受试者平均年龄为（60.0±7.5）岁。调整地区、性别、年龄、体质指数、血压、血脂、是否患糖尿病、是否服用降压药物以及饮酒等因素后,与从不吸烟者比较,现在吸烟者（2.5%vs 1.8%,OR=1.42,95%CI：1.05-1.92,P=0.022）、曾经吸烟者（3.6%vs 1.8%,OR=1.50,95%CI：1.04-2.17,P=0.030）肾功能下降（e GFR〈60 ml/min/73m2）的患病率均显著增加;同时,吸烟与血压水平升高（收缩压≥21.28 k Pa vs〈21.28 k Pa,交互作用P=0.006）在导致肾功能下降患病率增加具有显著协同作用。结论现在或曾经吸烟的高血压患者肾功能下降的患病率显著增加。血压水平升高与吸烟在导致肾功能下降患病增加具有协同作用。提示吸烟者更为严格的血压控制可以减轻肾脏靶器官的早期损害。

Objective To investigate the effect of smoking on renal function decline in rural hypertensive population residing in Eastern China,and provide a preliminary basis for early prevention of chronic kidney disease.Methods 20 702 subjects with hypertension aged 45 - 75 years old were enrolled. Cigarette smoking was collected by standardized questionnaire; renal function was estimated by glomerular filtration rate（ GFR） using the CKD-EPI formula. Results A total of 20 312 participants（ 60. 0 ± 7. 5 years of age） were the final subjects in the study.Logistic regression analysis showed that compared with non-smokers,the prevalence of renal function decline was significantly higher in current smokers（ 2. 5% vs 1. 8%,OR = 1. 42,95% CI： 1. 05 - 1. 92,P = 0. 022） and former smokers（ 3. 6% vs 1. 8%,OR = 1. 50,95% CI： 1. 04 - 2. 17,P = 0. 030） after adjusting for study center,gender,age,body mass index,blood pressure,serum lipids,history of diabetes mellitus,taking antihypertensive drugs and alcohol consumption. Meanwhile,cigarette smoking and elevated blood pressure（ systolic blood pressure≥21. 28 k Pa vs 〈21. 28 k Pa,P value for interaction was 0. 006） had a synergistic effect in prevalence of renal function decline. Conclusion Cigarette smoking（ both current and former smokers） is significantly associated with the renal function decline in hypertensive patients. Elevated blood pressure levels and smoking have a synergistic effect on prevalence of renal function decline. It prompts that smokers who have a more stringent blood pressure control could reduce the early injury of renal target organs.